|
URINALYSIS MICROSCOPIC ONLY
|
Facility
|
IP
|
$54.80
|
|
|
Service Code
|
CPT 81015
|
| Hospital Charge Code |
3008101501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$40.56 |
| Max. Negotiated Rate |
$52.06 |
| Rate for Payer: Aetna of VT Commercial |
$52.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$40.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$40.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$46.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$46.03
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$43.84
|
| Rate for Payer: Cash Price |
$27.40
|
| Rate for Payer: Cigna Commercial |
$43.84
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$43.84
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$43.84
|
| Rate for Payer: Multiplan Commercial |
$50.96
|
| Rate for Payer: MVP Health Care of NY Commercial |
$46.58
|
| Rate for Payer: United Healthcare Commercial |
$52.06
|
|
|
URINALYSIS MICROSCOPIC ONLY
|
Facility
|
OP
|
$54.80
|
|
|
Service Code
|
CPT 81015
|
| Hospital Charge Code |
3008101501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.05 |
| Max. Negotiated Rate |
$52.06 |
| Rate for Payer: Aetna of VT Commercial |
$52.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$15.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$24.27
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$15.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$32.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$46.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$44.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$24.66
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$43.57
|
| Rate for Payer: Cash Price |
$27.40
|
| Rate for Payer: Cash Price |
$27.40
|
| Rate for Payer: Cigna Commercial |
$43.84
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$43.84
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$43.84
|
| Rate for Payer: Martins Point Health Care Commercial |
$24.66
|
| Rate for Payer: Multiplan Commercial |
$50.96
|
| Rate for Payer: MVP Health Care of NY Commercial |
$46.58
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$24.66
|
| Rate for Payer: United Healthcare Commercial |
$52.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.05
|
| Rate for Payer: United Healthcare VA CCN |
$24.66
|
|
|
URINALYSIS NONAUTO W/O SCOPE
|
Professional
|
Both
|
$13.44
|
|
|
Service Code
|
CPT 81002
|
| Hospital Charge Code |
3008100201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.43 |
| Max. Negotiated Rate |
$17.15 |
| Rate for Payer: Aetna of VT Commercial |
$12.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$17.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$3.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$17.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$4.87
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$4.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$4.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$4.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$4.65
|
| Rate for Payer: Cash Price |
$6.72
|
| Rate for Payer: Cash Price |
$6.72
|
| Rate for Payer: Cigna Commercial |
$4.36
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$3.48
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$3.48
|
| Rate for Payer: Martins Point Health Care Commercial |
$3.43
|
| Rate for Payer: Multiplan Commercial |
$12.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3.48
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$3.48
|
| Rate for Payer: United Healthcare Commercial |
$5.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.48
|
| Rate for Payer: United Healthcare VA CCN |
$3.48
|
|
|
URINALYSIS NONAUTO W/O SCOPE
|
Facility
|
IP
|
$13.44
|
|
|
Service Code
|
CPT 81002
|
| Hospital Charge Code |
3008100201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.95 |
| Max. Negotiated Rate |
$12.77 |
| Rate for Payer: Aetna of VT Commercial |
$12.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$9.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$9.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$11.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$11.29
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$10.75
|
| Rate for Payer: Cash Price |
$6.72
|
| Rate for Payer: Cigna Commercial |
$10.75
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$10.75
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$10.75
|
| Rate for Payer: Multiplan Commercial |
$12.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$11.42
|
| Rate for Payer: United Healthcare Commercial |
$12.77
|
|
|
URINALYSIS NONAUTO W/O SCOPE
|
Facility
|
OP
|
$13.44
|
|
|
Service Code
|
CPT 81002
|
| Hospital Charge Code |
3008100201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.48 |
| Max. Negotiated Rate |
$17.15 |
| Rate for Payer: Aetna of VT Commercial |
$12.77
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$17.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$5.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$17.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$8.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$11.42
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$10.89
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$6.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$10.68
|
| Rate for Payer: Cash Price |
$6.72
|
| Rate for Payer: Cash Price |
$6.72
|
| Rate for Payer: Cigna Commercial |
$10.75
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$10.75
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$10.75
|
| Rate for Payer: Martins Point Health Care Commercial |
$6.05
|
| Rate for Payer: Multiplan Commercial |
$12.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$11.42
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$6.05
|
| Rate for Payer: United Healthcare Commercial |
$12.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.48
|
| Rate for Payer: United Healthcare VA CCN |
$6.05
|
|
|
URINALYSIS NONAUTO W/SCOPE
|
Professional
|
Both
|
$59.97
|
|
|
Service Code
|
CPT 81000
|
| Hospital Charge Code |
3008100001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.96 |
| Max. Negotiated Rate |
$56.37 |
| Rate for Payer: Aetna of VT Commercial |
$56.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$19.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$4.14
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$19.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$5.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$6.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$6.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$4.62
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$6.88
|
| Rate for Payer: Cash Price |
$29.98
|
| Rate for Payer: Cash Price |
$29.98
|
| Rate for Payer: Cigna Commercial |
$4.76
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$4.02
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$4.02
|
| Rate for Payer: Martins Point Health Care Commercial |
$3.96
|
| Rate for Payer: Multiplan Commercial |
$55.77
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4.02
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$4.02
|
| Rate for Payer: United Healthcare Commercial |
$6.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.02
|
| Rate for Payer: United Healthcare VA CCN |
$4.02
|
|
|
URINALYSIS NONAUTO W/SCOPE
|
Facility
|
OP
|
$59.97
|
|
|
Service Code
|
CPT 81000
|
| Hospital Charge Code |
3008100001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.02 |
| Max. Negotiated Rate |
$56.97 |
| Rate for Payer: Aetna of VT Commercial |
$56.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$19.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$26.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$19.81
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$36.10
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$50.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$48.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$26.99
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$47.68
|
| Rate for Payer: Cash Price |
$29.98
|
| Rate for Payer: Cash Price |
$29.98
|
| Rate for Payer: Cigna Commercial |
$47.98
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$47.98
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$47.98
|
| Rate for Payer: Martins Point Health Care Commercial |
$26.99
|
| Rate for Payer: Multiplan Commercial |
$55.77
|
| Rate for Payer: MVP Health Care of NY Commercial |
$50.97
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$26.99
|
| Rate for Payer: United Healthcare Commercial |
$56.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.02
|
| Rate for Payer: United Healthcare VA CCN |
$26.99
|
|
|
URINALYSIS NONAUTO W/SCOPE
|
Facility
|
IP
|
$59.97
|
|
|
Service Code
|
CPT 81000
|
| Hospital Charge Code |
3008100001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$44.38 |
| Max. Negotiated Rate |
$56.97 |
| Rate for Payer: Aetna of VT Commercial |
$56.97
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$44.38
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$44.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$50.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$50.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$47.98
|
| Rate for Payer: Cash Price |
$29.98
|
| Rate for Payer: Cigna Commercial |
$47.98
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$47.98
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$47.98
|
| Rate for Payer: Multiplan Commercial |
$55.77
|
| Rate for Payer: MVP Health Care of NY Commercial |
$50.97
|
| Rate for Payer: United Healthcare Commercial |
$56.97
|
|
|
URINE BACTERIA CULTURE
|
Facility
|
IP
|
$76.52
|
|
|
Service Code
|
CPT 87088
|
| Hospital Charge Code |
3008708801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$56.63 |
| Max. Negotiated Rate |
$72.69 |
| Rate for Payer: Aetna of VT Commercial |
$72.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$56.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$56.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$65.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$64.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$61.22
|
| Rate for Payer: Cash Price |
$38.26
|
| Rate for Payer: Cigna Commercial |
$61.22
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$61.22
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$61.22
|
| Rate for Payer: Multiplan Commercial |
$71.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$65.04
|
| Rate for Payer: United Healthcare Commercial |
$72.69
|
|
|
URINE BACTERIA CULTURE
|
Facility
|
OP
|
$76.52
|
|
|
Service Code
|
CPT 87088
|
| Hospital Charge Code |
300870880
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.09 |
| Max. Negotiated Rate |
$72.69 |
| Rate for Payer: Aetna of VT Commercial |
$72.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$39.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$33.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$39.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$46.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$65.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$61.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$34.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$60.83
|
| Rate for Payer: Cash Price |
$38.26
|
| Rate for Payer: Cash Price |
$38.26
|
| Rate for Payer: Cigna Commercial |
$61.22
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$61.22
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$61.22
|
| Rate for Payer: Martins Point Health Care Commercial |
$34.43
|
| Rate for Payer: Multiplan Commercial |
$71.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$65.04
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$34.43
|
| Rate for Payer: United Healthcare Commercial |
$72.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.09
|
| Rate for Payer: United Healthcare VA CCN |
$34.43
|
|
|
URINE BACTERIA CULTURE
|
Facility
|
OP
|
$76.52
|
|
|
Service Code
|
CPT 87088
|
| Hospital Charge Code |
3008708801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.09 |
| Max. Negotiated Rate |
$72.69 |
| Rate for Payer: Aetna of VT Commercial |
$72.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$39.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$33.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$39.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$46.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$65.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$61.98
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$34.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$60.83
|
| Rate for Payer: Cash Price |
$38.26
|
| Rate for Payer: Cash Price |
$38.26
|
| Rate for Payer: Cigna Commercial |
$61.22
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$61.22
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$61.22
|
| Rate for Payer: Martins Point Health Care Commercial |
$34.43
|
| Rate for Payer: Multiplan Commercial |
$71.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$65.04
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$34.43
|
| Rate for Payer: United Healthcare Commercial |
$72.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.09
|
| Rate for Payer: United Healthcare VA CCN |
$34.43
|
|
|
URINE BACTERIA CULTURE
|
Professional
|
Both
|
$76.52
|
|
|
Service Code
|
CPT 87088
|
| Hospital Charge Code |
300870880
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.98 |
| Max. Negotiated Rate |
$71.93 |
| Rate for Payer: Aetna of VT Commercial |
$71.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$39.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$8.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$39.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$11.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$9.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$9.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$9.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$9.53
|
| Rate for Payer: Cash Price |
$38.26
|
| Rate for Payer: Cash Price |
$38.26
|
| Rate for Payer: Cigna Commercial |
$9.92
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$8.09
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$8.09
|
| Rate for Payer: Martins Point Health Care Commercial |
$7.98
|
| Rate for Payer: Multiplan Commercial |
$71.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$8.09
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$8.09
|
| Rate for Payer: United Healthcare Commercial |
$12.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.09
|
| Rate for Payer: United Healthcare VA CCN |
$8.09
|
|
|
URINE BACTERIA CULTURE
|
Facility
|
IP
|
$76.52
|
|
|
Service Code
|
CPT 87088
|
| Hospital Charge Code |
300870880
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$56.63 |
| Max. Negotiated Rate |
$72.69 |
| Rate for Payer: Aetna of VT Commercial |
$72.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$56.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$56.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$65.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$64.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$61.22
|
| Rate for Payer: Cash Price |
$38.26
|
| Rate for Payer: Cigna Commercial |
$61.22
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$61.22
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$61.22
|
| Rate for Payer: Multiplan Commercial |
$71.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$65.04
|
| Rate for Payer: United Healthcare Commercial |
$72.69
|
|
|
URINE BACTERIA CULTURE
|
Professional
|
Both
|
$76.52
|
|
|
Service Code
|
CPT 87088
|
| Hospital Charge Code |
3008708801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.98 |
| Max. Negotiated Rate |
$71.93 |
| Rate for Payer: Aetna of VT Commercial |
$71.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$39.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$8.33
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$39.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$11.33
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$9.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$9.53
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$9.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$9.53
|
| Rate for Payer: Cash Price |
$38.26
|
| Rate for Payer: Cash Price |
$38.26
|
| Rate for Payer: Cigna Commercial |
$9.92
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$8.09
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$8.09
|
| Rate for Payer: Martins Point Health Care Commercial |
$7.98
|
| Rate for Payer: Multiplan Commercial |
$71.16
|
| Rate for Payer: MVP Health Care of NY Commercial |
$8.09
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$8.09
|
| Rate for Payer: United Healthcare Commercial |
$12.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.09
|
| Rate for Payer: United Healthcare VA CCN |
$8.09
|
|
|
URINE CULTURE/COLONY COUNT
|
Facility
|
OP
|
$76.37
|
|
|
Service Code
|
CPT 87086
|
| Hospital Charge Code |
300870860
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.07 |
| Max. Negotiated Rate |
$72.55 |
| Rate for Payer: Aetna of VT Commercial |
$72.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$39.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$33.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$39.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$45.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$64.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$61.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$34.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$60.71
|
| Rate for Payer: Cash Price |
$38.19
|
| Rate for Payer: Cash Price |
$38.19
|
| Rate for Payer: Cigna Commercial |
$61.10
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$61.10
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$61.10
|
| Rate for Payer: Martins Point Health Care Commercial |
$34.37
|
| Rate for Payer: Multiplan Commercial |
$71.02
|
| Rate for Payer: MVP Health Care of NY Commercial |
$64.91
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$34.37
|
| Rate for Payer: United Healthcare Commercial |
$72.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.07
|
| Rate for Payer: United Healthcare VA CCN |
$34.37
|
|
|
URINE CULTURE/COLONY COUNT
|
Facility
|
OP
|
$76.37
|
|
|
Service Code
|
CPT 87086
|
| Hospital Charge Code |
3008708601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.07 |
| Max. Negotiated Rate |
$72.55 |
| Rate for Payer: Aetna of VT Commercial |
$72.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$39.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$33.82
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$39.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$45.97
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$64.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$61.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$34.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$60.71
|
| Rate for Payer: Cash Price |
$38.19
|
| Rate for Payer: Cash Price |
$38.19
|
| Rate for Payer: Cigna Commercial |
$61.10
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$61.10
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$61.10
|
| Rate for Payer: Martins Point Health Care Commercial |
$34.37
|
| Rate for Payer: Multiplan Commercial |
$71.02
|
| Rate for Payer: MVP Health Care of NY Commercial |
$64.91
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$34.37
|
| Rate for Payer: United Healthcare Commercial |
$72.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.07
|
| Rate for Payer: United Healthcare VA CCN |
$34.37
|
|
|
URINE CULTURE/COLONY COUNT
|
Facility
|
IP
|
$76.37
|
|
|
Service Code
|
CPT 87086
|
| Hospital Charge Code |
300870860
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$56.52 |
| Max. Negotiated Rate |
$72.55 |
| Rate for Payer: Aetna of VT Commercial |
$72.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$56.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$56.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$64.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$64.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$61.10
|
| Rate for Payer: Cash Price |
$38.19
|
| Rate for Payer: Cigna Commercial |
$61.10
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$61.10
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$61.10
|
| Rate for Payer: Multiplan Commercial |
$71.02
|
| Rate for Payer: MVP Health Care of NY Commercial |
$64.91
|
| Rate for Payer: United Healthcare Commercial |
$72.55
|
|
|
URINE CULTURE/COLONY COUNT
|
Facility
|
IP
|
$76.37
|
|
|
Service Code
|
CPT 87086
|
| Hospital Charge Code |
3008708601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$56.52 |
| Max. Negotiated Rate |
$72.55 |
| Rate for Payer: Aetna of VT Commercial |
$72.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$56.52
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$56.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$64.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$64.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$61.10
|
| Rate for Payer: Cash Price |
$38.19
|
| Rate for Payer: Cigna Commercial |
$61.10
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$61.10
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$61.10
|
| Rate for Payer: Multiplan Commercial |
$71.02
|
| Rate for Payer: MVP Health Care of NY Commercial |
$64.91
|
| Rate for Payer: United Healthcare Commercial |
$72.55
|
|
|
URINE CULTURE/COLONY COUNT
|
Professional
|
Both
|
$76.37
|
|
|
Service Code
|
CPT 87086
|
| Hospital Charge Code |
3008708601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.96 |
| Max. Negotiated Rate |
$71.79 |
| Rate for Payer: Aetna of VT Commercial |
$71.79
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$39.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$8.31
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$39.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$11.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$11.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$11.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$9.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$11.11
|
| Rate for Payer: Cash Price |
$38.19
|
| Rate for Payer: Cash Price |
$38.19
|
| Rate for Payer: Cigna Commercial |
$9.92
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$8.07
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$8.07
|
| Rate for Payer: Martins Point Health Care Commercial |
$7.96
|
| Rate for Payer: Multiplan Commercial |
$71.02
|
| Rate for Payer: MVP Health Care of NY Commercial |
$8.07
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$8.07
|
| Rate for Payer: United Healthcare Commercial |
$12.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.07
|
| Rate for Payer: United Healthcare VA CCN |
$8.07
|
|
|
URINE PREGNANCY TEST
|
Facility
|
OP
|
$49.14
|
|
|
Service Code
|
CPT 81025
|
| Hospital Charge Code |
3008102501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.61 |
| Max. Negotiated Rate |
$46.68 |
| Rate for Payer: Aetna of VT Commercial |
$46.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$42.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$21.76
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$42.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$29.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$41.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$39.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$22.11
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$39.07
|
| Rate for Payer: Cash Price |
$24.57
|
| Rate for Payer: Cash Price |
$24.57
|
| Rate for Payer: Cigna Commercial |
$39.31
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$39.31
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$39.31
|
| Rate for Payer: Martins Point Health Care Commercial |
$22.11
|
| Rate for Payer: Multiplan Commercial |
$45.70
|
| Rate for Payer: MVP Health Care of NY Commercial |
$41.77
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$22.11
|
| Rate for Payer: United Healthcare Commercial |
$46.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.61
|
| Rate for Payer: United Healthcare VA CCN |
$22.11
|
|
|
URINE PREGNANCY TEST
|
Facility
|
IP
|
$49.14
|
|
|
Service Code
|
CPT 81025
|
| Hospital Charge Code |
3008102501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.37 |
| Max. Negotiated Rate |
$46.68 |
| Rate for Payer: Aetna of VT Commercial |
$46.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$36.37
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$36.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$41.77
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$41.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$39.31
|
| Rate for Payer: Cash Price |
$24.57
|
| Rate for Payer: Cigna Commercial |
$39.31
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$39.31
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$39.31
|
| Rate for Payer: Multiplan Commercial |
$45.70
|
| Rate for Payer: MVP Health Care of NY Commercial |
$41.77
|
| Rate for Payer: United Healthcare Commercial |
$46.68
|
|
|
URINE PREGNANCY TEST
|
Professional
|
Both
|
$49.14
|
|
|
Service Code
|
CPT 81025
|
| Hospital Charge Code |
3008102501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.49 |
| Max. Negotiated Rate |
$46.19 |
| Rate for Payer: Aetna of VT Commercial |
$46.19
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$42.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$8.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$42.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$12.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$14.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$14.70
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$9.90
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$14.70
|
| Rate for Payer: Cash Price |
$24.57
|
| Rate for Payer: Cash Price |
$24.57
|
| Rate for Payer: Cigna Commercial |
$10.31
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$8.61
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$8.61
|
| Rate for Payer: Martins Point Health Care Commercial |
$8.49
|
| Rate for Payer: Multiplan Commercial |
$45.70
|
| Rate for Payer: MVP Health Care of NY Commercial |
$8.61
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$8.61
|
| Rate for Payer: United Healthcare Commercial |
$13.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.61
|
| Rate for Payer: United Healthcare VA CCN |
$8.61
|
|
|
UROGRAPHY RTRGR +-KUB
|
Professional
|
Both
|
$1,611.00
|
|
|
Service Code
|
CPT 74420
|
| Hospital Charge Code |
9827442001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$74.82 |
| Max. Negotiated Rate |
$1,514.34 |
| Rate for Payer: Aetna of VT Commercial |
$1,514.34
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$233.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$77.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$233.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$104.75
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$94.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$94.76
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$86.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$94.76
|
| Rate for Payer: Cash Price |
$805.50
|
| Rate for Payer: Cash Price |
$805.50
|
| Rate for Payer: Cigna Commercial |
$113.64
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$120.35
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$120.35
|
| Rate for Payer: Martins Point Health Care Commercial |
$74.82
|
| Rate for Payer: Multiplan Commercial |
$1,498.23
|
| Rate for Payer: MVP Health Care of NY Commercial |
$74.82
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$74.82
|
| Rate for Payer: United Healthcare Commercial |
$115.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$74.82
|
| Rate for Payer: United Healthcare VA CCN |
$74.82
|
|
|
UROGRAPHY RTRGR +-KUB
|
Facility
|
OP
|
$1,611.00
|
|
|
Service Code
|
CPT 74420
|
| Hospital Charge Code |
9827442001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$713.51 |
| Max. Negotiated Rate |
$1,530.45 |
| Rate for Payer: Aetna of VT Commercial |
$1,530.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,443.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$713.51
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,443.29
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$969.82
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,369.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,304.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$724.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,280.74
|
| Rate for Payer: Cash Price |
$805.50
|
| Rate for Payer: Cigna Commercial |
$1,288.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,288.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,288.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$724.95
|
| Rate for Payer: Multiplan Commercial |
$1,498.23
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,369.35
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$724.95
|
| Rate for Payer: United Healthcare Commercial |
$1,530.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$724.95
|
| Rate for Payer: United Healthcare VA CCN |
$724.95
|
|
|
UROGRAPHY RTRGR +-KUB
|
Facility
|
IP
|
$1,611.00
|
|
|
Service Code
|
CPT 74420
|
| Hospital Charge Code |
9827442001
|
|
Hospital Revenue Code
|
982
|
| Min. Negotiated Rate |
$1,192.30 |
| Max. Negotiated Rate |
$1,530.45 |
| Rate for Payer: Aetna of VT Commercial |
$1,530.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,192.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,192.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,369.35
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,353.24
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,288.80
|
| Rate for Payer: Cash Price |
$805.50
|
| Rate for Payer: Cigna Commercial |
$1,288.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,288.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,288.80
|
| Rate for Payer: Multiplan Commercial |
$1,498.23
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,369.35
|
| Rate for Payer: United Healthcare Commercial |
$1,530.45
|
|
